Maternity 7-2 Flashcards by Amanda S.

Endometriosis - symptoms (end the 3 Ds)

Dysmenorrhea
Pelvic discomfort
Infertility
Dyspareunia (pain after sex)
Depression

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Endometriosis - how long does it take to get diagnosed?

3-11 years between the onset of symptoms and dx.
Cause unknown
Endometrial tissue responds to cyclical hormonal stimulation

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Endometriosis: Risk factors - and what about age? (end early only)

Early age menarche (<12years)
Short menstrual cycles (<28 days)
Nulliparity
Heavy long periods (> 1 week)
Familial component (7-10X’s more likely if a 1st degree relative has it)

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Endometriosis: Symptoms (bowel movements?) (end the pain a day before)

Pelvic pain beginning 1-2 days before expected menses
Infertility
Heavy Menses
Fatigue
Dyspareunia
Dysuria
Painful bowel movements during periods
Other gastrointestinal upsets such as diarrhea, constipation, nausea.

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Endometriosis - meds (Tu is grrr)

Diagnosed by laparoscopy to allow for visualization and biopsy or ultrasound
Analgesics
Oral contraceptives
GnRH antagonists
Surgery

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Menopause

Complete cessation of menses for a period of 12 months resulting in loss of high levels of estrogen and progesterone.

(Average age 51.5 years)

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menopause - what happens hormonally?

lower ovarian response to FSH resulting in loss of primary estrogen and progesterone

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Symptoms menopause

Vaginal dryness
Vaginal walls become thinner, less elastic
Dyspareunia
lower Libido
Atrophy of the labia
Increase risk of yeast infections
General loss of pelvic muscle tone
Stress incontinence

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symptoms menopause (and breasts?)

Anxiety
Sleep disturbances
Depression
Weight gain and bloating
Irregular menses
Mastodynia (breast pain)
Headache
Hot Flashes

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Other Health Risks - menopause

Osteoporosis
Cardiovascular Disease

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Therapeutic Management and Nursing Care - menopause

Hormonal and Non-hormonal interventions
Recommendations have been changed over the last few years.
Care should be managed individually
Tx should be tailored to history, risk and need of client

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Vasomotor Instability (Hot Flashes)

Common, ~ 75-85% incidence
Non hormonal interventions:
Decrease alcohol, hot drinks, spicy foods
Stress management techniques
Layered clothing
Herbs (primrose)
Fluids

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bone mass - what is the % of loss?

Bone mass peaks between 25 & 35 years old
Rapid loss of bone mass after menopause
Bone loss in just the few years after onset of menopause may be as high as 20% of lifetime bone loss

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Osteoporosis - what is reduced?

About 10 million Americans have osteoporosis.
About 34 million are at risk for the disease
Bone mineral density is reduced.

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Are you @ risk for osteoporosis? what drugs cause it? (osteo fights w/ steroids)

Thin frame?
Caucasian or Asian?
Family History
Cortisone-like drugs for asthma, arthritis, or cancer?
Diet low in Calcium (<1000mg/day)?

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Are you @ risk for osteoporosis? what drinks cause it?

. Sedentary lifestyle
> 2 drinks with caffeine a day
> 2 drinks of alcohol per day?

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Soft drinks may also increase risk

2nd phosphoric acid
Tobacco believed to inhibit the activity of osteoblasts – fill in the cavities

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check slide

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Calcium Absorption decreases with (coffee) (pee out the coffee)

caffeine consumption> increases calcium excretion

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medications - osteoporosis (osteo is bi w/ calcitonin)

Bisphosphonates
Selective estrogen receptor modulators (SERMs)
Calcitonin

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how do osteoporosis meds work?

Medication either prevents calcium reabsorption or promotes bone formation. All treatments are recommend to be given with:
Calcium
Vitamin D
Diet
Exercise
Fall Prevention

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Cardio Vascular Disease - Does hormone therapy help? (cardio won’t help my hormones)

Life style
The importance of healty living before and AFTER menopause
Exercise
Diet
Smoking cessation
Hormone therapy DOES NOT reduce CVD

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Hormone Therapy

Previously know as HRT or Hormone Replacement Therapy.
Currently called Estrogen Therapy (ET), Progesterone Therapy (PT) or Hormone Therapy (HT)

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hormone therapy - advantages (what about bone?)

To provide relief of vasomotor symptoms (hot flashes)
To reduce the risk of unwanted pregnancy
To avoid the irregularity of menstrual cycles
To preserve bone
To improve quality of life (hot flash relief, improve sexual health)

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Hormone Therapy - side effects (4 things) (BBBH)

Bloating mastodynia vaginal bleeding Headaches

Nursing Considerations - hormone therapy - who can't take hormones?

Risks vs. benefits (e.g. Short term with out risk of CVD) Lowest dose for shortest duration Gradual withdrawal Should not be used by women with hx. Of Ca

Fibrocystic Breast Disease - what type of cysts? (cysts have fluid)

Benign Breast Disease Effects 50% - 60% women Overgrowth of fibrous tissue of the breasts accompanied by round, fluid filled cysts.

Fibrocystic Breast Disease - Symptoms (and where is the pain?)

with or without tenderness lumpy breasts feeling of fullness, dull heavy responds to hormones (either better or worse) Pain and tenderness – often In upper quadrants

Nursing Care for Fibrocystic Breast Disease - what test?

Steps in the work-up: Ultrasound - determines if cysts are solid or fluid filled

Nursing Care for Fibrocystic Breast Disease (fiber can't have caffeine, salt, or cigs)

Decrease Caffeine, salt, smoking Supportive bra NSAIDs OC’s (over the counter drugs)

Fibroadenoma - does it hurt, and what is it? (Aden doesn’t hurt)

Benign Solid Mass Smooth, round, mobile and painless

Breast Self-Exam  - when to do it

1 week after 1st day of menstruation Shower Inspect breasts Use methods Light pressure Deep pressure

Malignant Conditions of the Breast

Second leading cause of cancer death in women ages 45-55. One in eight American women will develop invasive breast cancer in her lifetime. 2.9 million survivors of breast cancer, with statistics indicating a survival rate of 83% at 10 years after diagnosis. At least 15% of cases are related to a genetic mutation

Types of Breast Cancer - invasive (lob in the 60s)

Invasive ductal carcinoma* - most common Invasive lobular carcinoma (more in the 60s)

staging of breast cancer (TNM)

Tumor size Extent of lymph node involvement Evidence of metastasis

stage 0

early, or in situ

stage 1 - how many inches?

localized, less than 1 inch in diameter

stage 2 - how many inches?

1-2 inches in diameter, usually w/ lymph nodes

stage 3 - how many inches?

2 inches or greater, spread to other lymph nodes and other tissues

stage 4

spread to organs

Risk Factors (modifiable)

High fat diet Nulliparity or 1st pregnancy >30 Alcohol consumption Obesity HRT Not breastfeeding Smoking Sedentary Lifestyle

Risk Factors (non-modifiable)

Age First degree relative with breast cancer Early Menarche, late menopause Genetic mutation (Braca 1 and Braca 2 genes) Hx of ovarian or colon cancer Fibrocystic Disease

Signs and Symptoms of Breast Cancer (single breast) and does it hurt?

Lump, often single, firm, and painless

Signs and Symptoms of Breast cancer

lump Skin appearance Asymmetry Superficial veins Dimple Nipple D/C retracted nipple

Diagnosis of Breast Cancer

Ultrasound Mammography Magnetic Resonance Mammography Biopsy Needle biopsy Excision biopsy

American Cancer Society Guide- lines for Breast Cancer Detection - when to start mammograms?

Normal Risk: Annual Mammograms starting age 45 (40-45 optional) Age 45 – 54 every year Age 55 and older every other year as long as they are in good health and have life expectancy of 10 years or more.

American Cancer Society Guide- lines for Breast Cancer Detection - high risk

High Risk: Risk 20-25% based on assessment tools BRCA1 or BRCA2 gene mutation 1st degree relative with BRCA1 Or BRCA2 Mammograms and MRI’s (in consultation with primary MD)

Magnetic Resonance Mammography (does it use contrast?)

Relatively new Highly sensitive Expensive (compliment to Mammograms) Uses contrast – to evaluate the rate dye enters breast tissue. Malignant lesions show increased distribution of the dye.

Treatment - breast cancer - when

Local or Systemic Is the tumor invasive or non-invasive? Size, grade, lymph node involvement Hormone receptor status Is there the Braca 1 or Braca 2 genes

Treatment - breast cancer

Surgery Radiation Adjuvant Systemic therapy Chemotherapy: Administered soon after surgical removal of the tumor Hormonal Therapy : tamoxifen Targeted Therapy – HER2 protein Immunotherapy- ER + or PR+ Reconstructive Surgery

Total simple mastectomy

one breast

Nursing Considerations - reconstructive surgery

Emotional support after diagnosis Preoperative care Immediate postoperative care Discharge planning and follow-up care Teaching needs for client and family undergoing adjuvant therapies

benign growths (polyps or cysts)

Polyps Fibroids Genital Fistula Bartholin Cyst Ovarian Cysts

Leiomyomas (Fibroids) (lei tu)

Benign tumors of accumulated muscle and fibrous tissue of unknown etiology

Leiomyomas- Signs and Symptoms

Heavy bleeding (which can be heavy enough to cause anemia or painful periods. Feeling of fullness or pressure in the pelvic area Enlargement of the lower abdomen Frequent urination Pain during sex Lower back pain

Leiomyomas – Nursing Care

Surgery Myomectomy Hysterectomy Edometrial Ablation –removal of the lining of the endometrius Myolysis –electric current or freezing of the the fibroid Uterine Fibroid Emoblization or uterine artery embolization - stops blood flow to the fibroid. Symptomatic relief NSAIDS Iron Hormones (BCP) Decrease after menopause

Cancers of the Reproductive Tract

Ovarian Cancer Endometrial Cancer Cervical Cancer Vaginal Cancer Vulvular Cancer

cycle of abuse - 1-4 (the abuser is a TIRC)

1 - tension building, 2 - incident, 3 - reconciliation, 4 - calm

The ABC’s of Patient Care: A

Alone: reassure the woman that she is not alone, that there have been others in her position before, and that help is available.

Documentation. Descriptive documentation. A clear statement by the woman about the abuse without subjective opinion Accurate description of injuries Photographs, taken with the victim's permission.

education

safety. sometimes greatest risk is when womcan tries to leave

calcium absorption and alcohol

alcohol consumption> inteferes with calcium absorbtion

calcium absorption - phosphate? protein?

phosphate consumption Excessive protein consumption

hormone therapy - what is given w/ progesterone? and why?

Progesterone is given with estrogen to decrease the incidence of endometrial cancer in women at Risk.

hormone therapy - increased risk of (UB on hormones)

uterine CA breast CA blood clots

fibrotic breast disease - If lump is solid, what test?

If lump is solid, a mammogram is obtained for > 35 years

fibrotic breast disease - If fluid filled

FNA (fluid needle aspiration)

fibrotic breast disease - If not fluid filled

Core biopsy is done

fibroadenoma - menstrual cycle?

Not sensitive to the menstrual cycle

fibroadenoma - size?

Increase in size in pregnancy and decreases with age

fibroadenoma - how to diagnose? (fibro to the core)

Work up may include a core biopsy.

types of breast cancer - in situ

Ductal carcinoma in situ (confined) Lobular carcinoma in situ Inflammatory carcinoma (rare, mimics an infection)

Modified radical mastectomy - (radical, leave me some nodes)

(don't take all nodes)

Skin- or scar-sparing mastectomy

Nipple- and areola-sparing mastectomy (nerves may be affected)

fibroids and pregnancy and labor

Complications during pregnancy and labor, including a six-time greater risk of cesarean section.

Belief: Articulate your belief in the victim, violence is not acceptable in any situation, that the abuse is not her fault and no one deserves to be hurt or mistreated.

Confidentiality. Ensure the confidentiality of the information that is being provided and explain the implication of mandatory reporting laws, where applicable.

osteoporosis meds - (osteo is friends w/ covid and esther)

Monoclonal antibodies Hormonal medications Estrogen therapy (considered a second-line therapy for osteoporosis)

most common type of breast cancer

Invasive ductal carcinoma

Maternity 7-2 Flashcards

(80 cards)